Provider Demographics
NPI:1982969945
Name:DEKONA, TANYA (MS, OT/LICENSED)
Entity Type:Individual
Prefix:MS
First Name:TANYA
Middle Name:
Last Name:DEKONA
Suffix:
Gender:F
Credentials:MS, OT/LICENSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7407 BUFFALO AVENUE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-4125
Mailing Address - Country:US
Mailing Address - Phone:301-585-0926
Mailing Address - Fax:
Practice Address - Street 1:7407 BUFFALO AVE
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-4125
Practice Address - Country:US
Practice Address - Phone:301-585-0926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119002795225X00000X
MD04317225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist